HomeMy WebLinkAbout07-06-15 (2) 1505614134
EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 4 0 2 7 8
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 3 1 0 2 0 1 4 0 7 1 8 1 9 2 3
Decedent's Last Name Suffix Decedent's First Name MI
SHOEMAKER ROBERT J
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
0 1.Original Return ❑ 2.Supplemental Return ❑ 3.Remainder Return(date of death
Prior to 12-13-82)
❑ 4.Agriculture Exemption ❑ 5.Future Interest Compromise(date of ❑ 6. Federal Estate Tax Return Required
(date of death on or after 7-1-2012) death after 12-12-82)
0 7.Decedent Died Testate ❑ 8. Decedent Maintained a Living Trust 0 9.Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
❑ 10.Litigation Proceeds Received ❑ 11.Non-Probate Transferee Return ❑ 12.Deferral/Election of Spousal Trusts
(Schedule F and G Assets only)
❑ 13.Business Assets ❑ 14.Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
J OE R . Z U L L I N G E R 71 7 264 6029
First Line of Address
1 4 NORTH MAI N STREET
Second Line of Address
S U I T E 2 0 0
City or Post Office State ZIP Code
CHAMBERSBURG PA 1 7 2 0 1
rn MI
Correspondent's e-mail address: izuIlingerap ZUllinger-daVIS.COn1 = C) ql
RFaSmeR�WILLS USE.O(VI£P ;
r r.r,i M
REGISTER OF WILLS USE ONLY Ln
DATE FILED MMDDYYYY GD O
:> C:_ G7
rte. M �p
* DATE FILED MP `n,. . '•
PLEASE USE ORIGINAL FORM ONLY
Side 1
I IIIIII VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIII
1505614134 1505614134 \
1505614234
REV-1500 EX(FI)
Decedent's Social Security Number
Decedents Name: ROBERT J. SHOEMAKER
RECAPITULATION
1. Real Estate(Schedule A) .. .. . . . ........ . . ......... . . . . . ......... . . . 1.
2. Stocks and Bonds(Schedule B) ... . . . ....... . . . . . .. ........ . . . . ...... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . .. 3.
4. Mortgages and Notes Receivable(Schedule D) . . .. . ..... . . . .. .... .. . . . .. 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . .... 5. 4 6 3 8 0 • 5 7
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . .... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested ....... 7.
8. Total Gross Assets(total Lines 1 through 7) ................ ... . . ...... 8. 4 6 3 8 0 , 5 7
9. Funeral Expenses and Administrative Costs(Schedule H) ....... . ... . . ..... 9. 1 2 5 8 9 • 0 5
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . . . . . ....... 10. 9 8 1 3 • 9 7
11. Total Deductions(total Lines 9 and 10) ...... .. . . . .... ............. . . . 11. 2 2 4 0 3 . 0 2
12. Net Value of Estate(Line 8 minus Line 11) . . .................. .. . . .... 12. 2 3 9 7 7 . 5 5
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) .. .. . . . . . .... ........ . 13.
14. Net Value Subject to Tax(Line 12 minus Line 13) . .. ............... . .. . 14. 2 3 9 7 7 . 5 5
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0 _ 0 . 0 0 15. 0 . 0 0
16. Amount of Line 14 taxable .
at lineal rate X.045 2 3 9 7 7 . 5 5 16. 1 0 7 8 . 9 9
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 . 0 0
19. TAX DUE ........... . ........ . . ....... . . . . ................ ..... 19. 1 0 7 8 . 9 9
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Under penalties of perjury,I declare I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the person responsible for filing the return is based on all information'of which preparer has
any knowledge.
SIGN RE OF PERSPN NG RETUR ATE
AD RESS
6002 Greenbriar Terrace Fayetteville, PA 17222
SI A RE FPRE OTTH P RSON RESPONSIBLE FOR FILING THE RETURN DTE
4 'tj�
/
AD' ESS
1 North Main Stra Suite 2 Chambersburg PA 17201
111111111111111111111111111111111111111 IN Side 2
1505614234 1505614234
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address: 21 14 0278
DECEDENTS NAME
ROBERT J. SHOEMAKER
STREET ADDRESS
CITY STATE ZIP
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1,078.99
2. Credits/Payments
A.Prior Payments
B.Discount
(See instructions.) Total Credits(A+B) (2) 0.00
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This'is the TAX DUE. (5) 1,078.99
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred ...................................................................... ❑ ❑X
b. retain the right to designate who shall use the property transferred or its income ❑ ❑X
c. retain a reversionary interest ........................................................ ❑
IZI
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 0
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ ❑x
3. Did decedent own an"in trust for"or payable-upon-death bank account or security.at his or her death? ......... ❑ 0 . .
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation?.................................................................................................. ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994,and before Jan. 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent or a step-parent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedenfs siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
ROBERT J. SHOEMAKER 21 14 0278
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Gross proceeds from sale of mobile home situate on rented lot at 239 SME, 44,500.00
Shippensburg, PA 17257 (copy of settlement sheet attached)
2. Received on propration of real estate taxes at sale of mobile home 101.42
3. Received on proration of lot rental at sale of mobile home 183.00
4. Checking Account#103010012, Orrstown Bank 251.11
5. Proceeds from private sale of decedent's automobile 1,200.00
6. Refund from Travelers Insurance 77.00
7. Refund from Adams Electric 25.90
8. Refund from Comcast Cable 42.14
s
TOTAL(Also enter on Line 5,Recapitulation) $ 46 380.57
If more space is needed,use additional sheets of paper of the same size.
REV-1511 Ex+(08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ROBERT J. SHOEMAKER 21 14 0278
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Duggan Funeral Home 3,553.90
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Years)Commission Paid:
2. Attorney Fees: Joel R. Zullinger 2,500.00
3. Family Exemption:(If decedent's address is not the same as claimants,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: JCS fee-23.50; automation 5.00; letters 20.00;will 15.00; filing return 178.50
15.00; filing inventory 15.00; short certificates 15.00; additional cost of letters 70.00
5 Accountant Fees:
6. Tax Return Preparer Fees:
7. Cumberland Law Journal, advertise letters 75.00
8. Amerigas, balance due on account 311.61
9. News-Chronicle, advertise letters 137.75
10. Darlene M. Kelly, CPA, prepare rebate forms 50.00
11. 2014 County taxes on mobile home 164.06
12. 1 st installment on 2014 School taxes on mobile home 176.23
13. Realtor's commission on sale of mobile home 3,300.00
14. Title services at sale of mobile home 10.00
15. Barry Negley, Tax Collector, tax certification fee at sale of mobile home 10.00
16. Mann Plumbing & Heating, plumbing repairs prior to sale of mobile home 460.00
17. Samuel W. Beattie Electrical Contractor, electrical repairs prior to sale of mobile home 58.00
18. Amerigas, gas bill due at sale of mobile home 1,135.00
TOTAL(Also enter on Line 9,Recapitulation) $ 12 589.05
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES&LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ROBERT J. SHOEMAKER 21 14 0278
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Summit Physician Services, medical services 68.45
2. Phillips&Cohen Associates, Ltd., claim filed against the estate for unpaid VISA credit 9,745.52
card account through Orrstown Bank
TOTAL(Also enter on Line 10,Recapitulation) $ 9,813.97
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ROBERT J. SHOEMAKER 21 14 0278
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. Russell W. Brookens, Jr. Lineal
one-half of residue
one-half of the residue
2. Richard A. Shoemaker, 1385 Second Avenue, Chambersburg, Lineal
PA 17202 one-half of residue
one-half of residue
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
I I
JRZ - 5 . 1 shoemaker. lw March 1, • 2006
1M=C70R•D-ED OFFICE OF
REGISTER OF WILLS
2014 MRR 2.6 Ail 10 44
CLERK OF
LAST WILL AND TESTAMEWPHANS' COURT
CUMBERLAND GO.., PA
I, ROBERT J. SHOEMAKER, of 239 Shippensburg Mobile Estates,
Shippensburg, Pennsylvania, being of sound and disposing mind,
memory and understanding, do hereby declare this to be my will,
hereby revoking any and all former wills and codicils thereto by me
heretofore made.
I.
I direct that all my just debts and funeral expenses,
including all expenses of my last illness, shall be paid from my
estate as soon as practicable after my decease as a part of the
expense of the administration of my estate.
I give, devise and bequeath the residue of my estate of every
nature and wherever situate to my wife, Peggy L. Shoemaker,
providing she shall survive me by thirty days .
III.
Should my wife, Peggy L. Shoemaker predecease me or die on or
before the thirtieth day following my death I give,. devise -and
bequeath the residue of my estate of every nature and wherever
situate to my children, namely Russell W. Brookens, Jr. and Richard
A. Shoemaker, in equal shares, provided that the share of any child
who predeceases me. or dies on or before the thirtieth day following
my death shall be distributed to said beneficiary' s issue, per
stirpes, living on the thirty-first day following my death, and in
default of any such then-living issue, such share shall be added to
the share or shares of my other children.
IV.
Any fiduciary under this will shall have the following powers
in addition to those vested in them by law and by other provisions
of my will applicable to all property whether principal or income,
including property held for minors, exercisable without Court
approval, and effective until actual distribution of all property:
A. To retain any and all of the assets of my estate, real or
personal, without regard to any principle of
diversification of risk.
B. To invest in all forms of property including stock,
common trust funds and mortgage investment funds without
restriction to investments authorized for Pennsylvania
fiduciaries as they deem proper, without regard to any
principle of diversification of risk.
C. To sell at public or private sale, to exchange or to
lease for any period of time any real or personal
Page 2
property and to give options for sales, exchanges or
leases, for such prices and upon such terms or conditions
as they deem proper.
D. : To allocate receipts and expenses to principal or income
or partly to each as they from time to time think proper.
E. To compromise any claim or controversy.
F. To distribute in cash or in kind or partly in each.
G. To hold property in their names without designation of
any fiduciary capacity or in the name of a nominee or
unregistered.
V.
I direct that all taxes that may be assessed in consequence of
my death of whatever nature and by whatever jurisdiction imposed,
shall be paid from my residuary estate as a part of the expense of
the administration of my estate.
VI.
I appoint my wife, Peggy L. Shoemaker as executrix of this my
will . Should my wife, Peggy L. Shoemaker predecease me, fail to
qualify or cease to act, I appoint my sons, Russell W. Brookens,
Jr. and Richard A. Shoemaker, as co-executors of this my will .
Page 3
VII.
No bond shall be required of any fiduciary hereunder in any
jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my
last will and testament, consisting of five typewritten pages, the
first three of which bear my signature in the margin for the
purpose of identification this _ "' day of
JJ�W41t�KAL)
Signed, sealed, published and declared by the above-named
testator as and for his last will and testament in our presence,
who in his presence, at his request and in the presence of each
other have hereunto set our hands as attesting witnesses .
pa-
All-
We,
We, ROBERT J. SHOEMAKER, % /n��_ )e , 7_ ; //U-C7 /�_ and
the testator and the witnesses respectively,
whose names are signed to the attached or foregoing instrument,
being first duly sworn, do _,iereby declare to the undersigned
authority that the testator signed and executed the instrument as
Page 4
his last will and testament and that he executed it as his free and
voluntary act for the purposes therein expressed and that each of
the witnesses, in the presence and hearing of the said testator
signed the will as witnesses and to the best of their knowledge
said signer was at that time eighteen years of age or older, of
sound mind and under no constraint or undue influence.
�a� 1
Testat
fitness
Witness
Subscribed, sworn to and acknowledged
before me by the above-named signer and
subscribed and sworn to before me by the
a ove-named witnesses this 21 day of
2
N : a ublic
COMMONWEALTH OF PEh SYLVANIA
Notarial Seal
Teresa J. Burkholder, Notary Public
Shi pensburg Boro, Cumberland County
My Conu-nission Expires Aug. 6, 2008
Member.Pennsylvania Association of Notaries
i
Page 5
PZthENTrjfi
oL OMB Approval No.2502-0265
A. Settlement Statement (HUD-1) NUD 1
w
O.'jt'C`7
B.Type of Loan Page 1 of 2
1.❑FHA 2.❑RHS 3•❑Conv.Unins. 6.File Number:
❑ 7.Loan Number:
4. VA 5.❑Cony.Ins. 401501745-8G 8.Mortgage Insurance Case Number:
C.NOTE. This form is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agent are shown.
Items marked"(p.a.c.)"were paid outside the e dosing;the y are shown here for informational purposes and are not included in the
D.Name and Address of Borrower
E.Name and Address of Setter F.Name and Address of Lender
ELIZABETH E.W.KIRK ANDERSON AND
ROBERT L.ANDERSON RUSSELL BROOKENS
3030 IONA TERRACE 23 SHIPPENSBURG MOBILE ESTATES
BALTIMORE,MD 21214 SHIPPENSBURG,PA 17257
G.Property Location
H.Settlement Agent
239 SHIPPENSBURG MOBILE ESTATES, GUARDIAN TRANSFER
PA 485 ST.JOHNS CHURCH ROAD,
SHIREMANSTOWN,PA 17011
COUNTY:CUMBERLAND Phone:(717)901-8342
PARCEL ID:36-12-0320-009-TR10324 Place of Settlement
TOWNSHIP:SHIPPENSBURG TOWNSHIP I.Settlement Date
464 GATEWAY AVE 06/16/2015
CHAMBERSBURG,PA 17201 Disbursement Date
�.Summa of Borrower's Transaction 06/16/2015
10..Gross Amount Due from Borrower 0 Summa r-
101.
Seller's Transaction
101. Contract Sales Price 400.Gross Amount Due to Seller
102, Personal pro a $44,500.00 401. Contract Sales Price
103. Settlement cha es to borrower tine 1400402• Personal Pro a $44,500.00
104. $705.00 403.
105. 404.
Ad ustment fpr items paid by seller in advance 405.
106. Ci /Town Taxes Ad•ustmentfor items aid b seller in advance
107. Court Taxes 146.16] r 6/1612015 to 1/1/2016 406• Ci (town Taxes
108. Assessments $79.69 407. County Taxes 146.16/yr 6/16/2015 to 1/1/2016
149. School Taxes528.74/yr 6]16]2015 to 7]1/2015 408• Assessments $79.69
June Lot Rent 365.04(mo for 6/16/',,415 to $21.73 409. School Taxes 528.70/yr 6/16/2415 to 7/1/2415
110. 1 2015 $1lune Lot Rent 366.00/mo for 6/16/2015 to $21.73
111. 83.00 410. 7 1 2415
$183.40
112. 411.
120.Gross Amount Due from Borrower412.
45 S
200.Amounts paid by or in Behalf of Borrower 489.42 420.Gross Amount Due to eller 44 784.42
201. Deposit or earnest money 500.Reductions In Amount Due to Seller
202. Prind al Loan Amount $540.04 501. Excess Deposits
203. Existin loan s taken subject to 502. Settlement Char es to Seller
204. 503. Existin loan s taken subject to 5442.86
205. 504.
206. 505.
207. 506.
208. 507.
209. 508.
Adjustments for items unpaid b seller 509.
210. Ci flown Taxes Adjustments for items un aid b seller
211. Coun Taxes 510. Ci own Taxes
212. Assessments 511. Court Taxes
213. 512. Assessments
214. 513.
215. 514,
216, 515.
217, 516.
218. 517.
219. 518.
220.Total Paid b /for Borrower 519.
500.00 520.Total Reduction Amount Due Seller
300.Cash at Settlement from/to Borrower S 442.86
341. Gross amount due from borrower(line 124 600.Cash at Settlement to/from Seller
302. Less amounts aid Dy/tor borrower line 224 45 489.42 601. Gross amount due to seller Ilne 420
500.00 602. Less reduttians .42
303.Cash X From To Borroin amount due seller line 520 wer 5442.86 442.86
.Cash X T From
The Public Reporting Burden for this coifed'on of information is estima ed a 35 minute.42 s per response for collecting reviewing, reporting the data.This agency may
39,341.56
not colied this information,and you are not required to complete this form,unless it displays a currently valid OMB control number.No confidentiality is assured;this
disclosure is mandatory.This is designed to provide the parties to a RESPA covered transaction with information during the settlement process.
Initials
401501745-BG HUD-1 Page 2 of 2
L.Settlement Charges
700.Total Real Estate Broker Fees$3500.00 Paid From Paid From
Division of Commission line 700 as follows: Borrower's Funds Seller's Funds
701. $1800.00 to Coldweli Banker Residential Brokerage$1500.00+$300.00 At Settlement At Settiement
702. $1800.00 to Coldwell Banker Residential Brokerage$1500.00+$300.00
703.Commission paid at settlement $300.00 $3,300.00
704.
800.Items Payable in Connection with Loan
801.Our origination charge from GFE#1
802.Your credit or charge(points)for the specific interest rate chosen from GFE#2
803.Your adjusted origination charges from GFE A
804.Appraisal Fee from GFE#3.
805. Credit report from GFE#3
806.Tax Service from GFE#3
IlkFlood Cert.Fee from GFE#3
808.
400.Items Required by Lender to Be Paid In Advance
901. Daily interest charges (from GFE#10
902.Mortgage Insurance Premium from GFE#3
903. Homeowner's Insurance from GFE#11)
904.
1000.Reserves Deposited with Lender
1001.Initial deposit for your escrow account from GFE#9
1002.
1003.
1004.
1005.
1006.
1007.
1100.Titte Charges
1101.Title services and lender's title insurance to Guardian Transfer from GFE#4 $305.00 10.00
1102.Settlement or closing fee to Guardian Transfer $295.00
1103.Owner's title insurance (from GFE#5
1104.Lender's title insurance
1105.Lender's tittle policy limit $0.00
.1106.Owner's title policy limit $44,500.00
110Agent's portion of the total title insurance premium
1108.7.Underwriter's portion of the total title insurance premium to TRGC
1200.Government Recording and Transfer Charges
1201.Government recording charges from GFE#7
1202.Deed$ Mortgage$ Releases$
1203.Transfer taxes from GFE#8
1204.Ci /Coup tax/stamps Deed Mortgage
1205.State tax/stamps Deed$ Mortgage$
1206.
1300.Additional Settlement Charges
1301.Required services that you can shop for from GFE#6
1302.Nota Fee/Tltle processing fee to Stouffer's Custom Cycles $50.00
1303.Application for transfer of title to Commonwealth of Pennsylvania $50.00
1304.Tax Certification to Barry L.Negley,Tax Collector $10.00
1305.Plumbing Repairs to Mann Plumbing&Heating 150.00
1306.Plumbing Repairs to Mann Plumbing&Heating 310.00
1307.Electrical Repairs to Samuel W.Beattie Electrical Contractor $58.OD
1308.Gas to AmeriGas $1,135.86
1309.Roof Repair to Nunemaker's Roofing and Construction 469.00
1400.Total Settlement Charges(enter on lines 103,Section 3 and s02,Section K) 1 $705.001 $5,442.86
If you have any questions about the settlement charges and loan terns listed on this form,please contact your lender.Settlement agent is not responsible for content of
lenders assessments on HUD.
The sellers and borrowers signatures hereon acknowledge their approval and signify their understanding that tax and Insurance prorations and reserves are based on
figures nt of any change for the current year,all necessary
be made between borng rower eer and seor lerEed by others or directly.Any deficitrmated for the current year.and in the deli delinquent taxes or mortgage payoffs will be promptly reimbursed o the settlement agent by theuselle. will
i have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,it is true and accurate statement of all receipts and
disbursements made on my account or by me in this transaction.I further certify that I have received a Copy of the HUD-1 Settlement Statement.
BUYERS SELLS
d
Eti be ilk erso ' Ru seal rookens
n .
Robert L.Anderson
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction.I have caused or will cause the funds to be disbursed In
accordance with this statement.
Settleme gentnate
��, 06/1612015
'Any items marked"POC'were paid outside closing by:Borrower POC(8),Lender POC(L),Mortgage Broker POC(M),Seiler POC(S),Real Estate Agent POC(R),
or Other POG(0).
March 31,2014
Zullinger-Davis
Law Office -
20 E Surd St,Po Box 40
Shippensburg,Pa 17257
Fax:717-530-5222
Re: Estate of Robert J Shoemaker
Social Security Number
Date of Death 03/10/14
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD THE
FOLLOWING ACCOUNT WITH ORRSTOWN BANK:
CHECKING ACCOUNT
Account No- 103010012
Account Type- 50+Interest Checking
Account Title- Robert J Shoemaker
Date Opened- 10/20/11
Joint Account(name/date) No
Balance- $251.11
Accrued Interest $0.00
Best Regards,
Lisa Kline
Deposit Processing Clerk